Provider Demographics
NPI:1649431073
Name:AGUSTINES, JAMES
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:AGUSTINES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11093 BOREN AVE
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-6518
Mailing Address - Country:US
Mailing Address - Phone:951-990-3257
Mailing Address - Fax:909-498-4175
Practice Address - Street 1:11093 BOREN AVE
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-6518
Practice Address - Country:US
Practice Address - Phone:951-990-3257
Practice Address - Fax:909-498-4175
Is Sole Proprietor?:No
Enumeration Date:2008-06-18
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA177962278H0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2278H0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedHome Health